Print version ISSN 1681-150X

Abstract

We reviewed 28 patients in order to assess the outcome of tuberculosis of the foot and ankle in children and to describe a classification that would relate to prognosis. The median age was 3 years (1 to 12.5 years). The ankle was involved in 13 (46.4%) patients, the midfoot in nine (32.1%), the subtalar joint in five (17.9%) and the calcaneus in one (3.6%). Radiographs of ankle joint involvement showed osteopaenia with or without lytic lesions of the distal tibial epiphysis, sclerosis or lytic lesions of the dome of the talus, or joint space narrowing. Midfoot involvement showed osteopaenia with or without 'absence' of bone (cuneiforms, cuboid and navicular). Subtalar involvement showed lytic lesions of the calcaneus and/or inferior talus that were not always visible on plain radiographs but were confirmed with CT scan in three patients. Open biopsy was done in all patients. Histology and/or culture were positive in 26 of 28 patients. Treatment was with isoniazid, rifampicin and pyrazinamide for 9 months. Two patients had multiple-drug-resistant tuberculosis and their drugs were modified accordingly. At a mean follow-up of 5.9 years (3 to 18 years) no patients had residual symptoms and all except one had a plantigrade foot. Ten patients (35.7%) had an excellent result, 14 patients (50%) a good and four patients (14.3%) had a poor result. Joint space narrowing was a reliable predictor of a poor outcome in the ankle joint (3/9). All patients with midfoot involvement had a good functional outcome, although the joint space was not always definable. One of the five patients with subtalar involvement had a poor result.